NEW YORK CITY YOUTH BOARD
Social Selenco
Library
HY
743
N5
A34
no.3
Youn
reaching
adolescents
THROUGH A COURT CLINIC
M
UNIVE SITY
OF MICHIGAN
FEB 17 1956
SOCIAL SCIENCE
LIBRARY
YOUTH BOARD MONOGRAPH NO. 3
L

Posed by a member of the staff of the New York City Youth Board.
A TALK WITH THE COURT PSYCHIATRIST

reaching
adolescents



NEW YORK
CITY
MONOGRAPH NO. 3
SLABETH"-T
THROUGH A COURT CLINIC
YOUTH
• JUNE
BOARD
1955
Social S Work
Library
HV
743
N5
A34
COPYRIGHT 1955
NEW YORK CITY YOUTH BOARD
500 PARK AVENUE
NEW YORK 22, N. Y.
бос
Geft
Work
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**
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NEW YORK CITY YOUTH BOARD
HON. ROBERT F. WAGNER
Mayor
HAROLD L. BACHE
MRS. RALPH J. BUNCHE
MRS. RAQUEL CAMPBELL
THOMAS F. COHALAN
ANTHONY DREXEL DUKE
GEORGE GREGORY, JR.
MRS. HARRY G. HILL
WILLIAM E. HILL
HENRY HOTCHKISS
MORRIS IUSHEWITZ
KENNETH D. JOHNSON
MRS. DAVID M. LEVY
ALEXANDER MARTIN, M.D.
PHILIP MICHAELS
WALTER A. MILLER
JAMES C. QUINN
ANTHONY J. SESSA
FRANCIS W. H. ADAMS
Police Commissioner
LEONA BAUMGARTNER, M.D.
Commissioner of Health
MAUDE M. CRAIG
Director of Research
NATHANIEL KAPLAN
MARIE DUFFIN
Director of Child Welfare
Chairman
IRVING BEN COOPER
Chief Justice
Court of Special Sessions
PHILIP J. CRUISE
Chairman, New York City
Housing Authority
JOHN WARREN HILL
Presiding Justice
Domestic Relations Court
WILLIAM JANSEN
Superintendent of Schools
ANNA M. KROSS
Commissioner of Correction
HENRY L. MCCARTHY
Commissioner of Welfare
ROBERT MOSES
Commissioner of Parks
JOHN M. MURTAGH
Chief City Magistrate
Magistrates' Court
RALPH W. WHELAN
Executive Secretary
ADMINISTRATIVE STAFF
RALPH W. WHELAN
Executive Director
JAMES E. MCCARTHY
Director of Group Work and
Recreation
KALMAN ROTHBAUM
Director of Audit and Control
ETTA M. STEELE
Staff Writer
TECHNICAL ADVISORY COMMITTEE ON CHILD WELFARE
MR. FREDERICK I. DANIELS, Chairman
MR. HERSCHEL ALT, Executive
Director, Jewish Board of
Guardians
MR. HAROLD L. BACHE, Member,
Youth Board Subcommittee on
Child Welfare
MRS. RALPH BUNCHE, Member,
Youth Board Subcommittee on
Child Welfare
MRS. RAQUEL CAMPBELL, Member,
Youth Board Subcommittee on
Child Welfare
DR. MAMIE P. CLARK, Director,
Northside Center for Child
Development
REV. ROBERT E. GALLAGHER,
Executive Director, Catholic
Charities Guidance Institute
MRS. LUISA FRIAS HEMPEL,
Supervisor, Education Section,
Migration Division, Department
of Labor, Government of Puerto
Rico
MR. FRANK J. HERTEL, Associate
General Director, Community
Service Society
MR. HENRY G. HOTCHKISS, Member,
Youth Board Subcommittee on
Child Welfare
MR. AARON L. JACOBY, Consultant,
Jewish Youth Services of Brooklyn
MRS. JOSEPH P. LASH, Executive
Director, Citizens Committee on
Children of New York City
MR. WILSON D. McKERROW,
Executive Director, Brooklyn
Society for the Prevention of
Cruelty to Children
REV. FRANCIS J. MUGAVERO, Director,
Queens County Office, Catholic
Charities Diocese of Brooklyn
DR. FRANK J. O'BRIEN, Associate
Superintendent, Board of
Education
REV. ALMON R. PEPPER, D.D.,
Director, Department of Christian
Social Relations, National Council
of the Protestant Episcopal Church
MR. SANFORD N. SHERMAN,
Assistant Executive Director,
Jewish Family Service
MRS. PAULINE TARG, Field
Representative, New York State
Youth Commission
THE MAGISTRATES' COURTS OF NEW YORK CITY
JOHN M. MURTAGH
Chief City Magistrate
JUDICIAL COMMITTEE
OF THE PSYCHIATRIC CLINIC
JUDGE PETER M. HORN, Chairman
JUDGE ABRAHAM M. BLOCH
JUDGE PHILLIP B. THURSTON*
DORRIS CLARKE
Chief Probation Officer
MAGISTRATES' COURTS PSYCHIATRIC CLINIC
PROFESSIONAL STAFF
MISS RUTH K. LYNCH
Clinic Administrator
DR. NORBERT BROMBERG
Consultant Psychiatrist
DR. MORTON J. ARONSON
Psychiatrist
DR. EDNITA BERNABEU
Psychiatrist
DR. MURRAY H. SHERMAN
Psychologist
*Now a justice with the Domestic Relations Court
FOREWORD: Dr. Norbert Bromberg
HISTORY OF THE NEW YORK CITY YOUTH BOARD.......
INTRODUCTION
CONTENTS
Rehabilitation Process
I. WHY A PSYCHIATRIC CLINIC IS NEEDED IN THE MAGISTRATES'
COURTS
··
II. STAFF, STRUCTURE AND RELATIONSHIP OF THE CLINIC TO THE
COURT
Part Played by Youth Board
Ways in Which Clinic Services Are Used
III. THE INTAKE PROCESS
Procedure
IV. THE TREATMENT PROCESS
Functions of the Therapist
…………
VI. CASELOAD ANALYSIS AND TREATMENT COSTS
VII. COURT, CLINIC AND COMMUNITY
PAGE
……………
.....
11.
14
17
51
V. CHARACTERISTICS OF ADOLESCENTS Referred to THE CLINIC ......
Personality Development of Adolescents Referred to the Clinic 53
21
22
24
25
26
32
33
38
39
57
60
9
FOREWORD
This monograph deals with what is essentially a pilot project, an experiment.
It concerns itself chiefly, of course, with the central problem: can a psy-
chiatric clinic for adolescents function successfully in a court setting and
how can it do so. In dealing with this issue, it must naturally focus on the
administrative and technical machinery and tools by which service is ren-
dered, as well as on the people who are the recipients of the service. Such a
focusing, which is mandatory in a presentation of this type, should not leave
the impression that the findings in relation to the patients and the machinery
of the clinic were the only ones that emerged. With regard to the factor of
obstacles to treatment, for instance, it was found that the resistances of the
patients were not the only ones that have to be dealt with. There may also
be important sources of resistance "closer home" to the clinic as well as
some in and around the home of the patient.
It is obvious that the conscious wishes of parents influence the behavior
of young children. But it is not as well recognized how often the unconscious.
wishes of parents stimulate in the young child, and continue to influence
in the case of the older one, behavior to which these parents raise the most
violent objections. Moreover, in adolescence especially, the gang and other
peer groups often have a vital effect on the attitudes and activities of the
young people within their orbit. Hopefully, now that the clinic has proved
itself, it will be expanded not only beyond the dimensions of a pilot project,
but to the point where it will be feasible to cope with such impediments
to successful treatment directly, or at least in effective liaison with such
existing agencies as the Youth Board's Service to Families and Children and
11
its project on gangs. In this way, it would be possible to feel that, while
the boat is being bailed out with only a teaspoon, at least the leak is being
dealt with to some extent.
To come closer home, no clinic staff confronted with the task described
in these pages, could possibly be without its resistances at the outset. Coming,
as almost all of them inevitably did, from other clinics, psychiatric hospitals,
social service agencies or private practice, to which patients usually come
eagerly seeking help, most members of the staff had grave doubts about
how much could be done with adolescents who often appear at the clinic
unwillingly, if not with outright hostility. It is of no minor significance
that this experiment was able to demonstrate that therapeutic benefits can
be derived from work with these patients under these circumstances and that
such work can, therefore, be very rewarding.
It is easy to take for granted that when at long last an undertaking such
as this is finally instituted, it would have the support of everyone involved.
Since a clinic attached to an agency of a large city involves indirectly as
well as directly a great many people, it is not surprising that the attitudes
of some of them should be characterized more by scepticism than by unal-
loyed enthusiasm. Of vital significance for the success of the clinic is the
fortunate fact that it had the unstinting support of those on whose direct
support it depended, namely the judges involved and their probation depart-
ment staffs, to say nothing of the wholehearted encouragement and coopera-
tion of the Youth Board personnel involved. Much of the resistance that
others may have offered was usually dissolved by the devoted efforts of
these friends of the clinic.
In this connection, a point that is only implicit in the work of the
clinic, deserves to be made explicit because of its fundamental importance.
The theoretician in the field of juvenile delinquency is inclined to approach
the problem with a plea for further research. No one can deny this need.
Those who work closer to the problem, however, while they welcome all the
additional theoretical and practical knowledge that can possibly be added,
feel that we would be in a position to accomplish a great deal more if we
could apply, at this time, a somewhat larger fraction of what is already
known about the subject. An inquiry into the basis for the fact that so
relatively little of our knowledge is implemented, reveals various causes.
One of these is the absence of communication between, on the one hand, the
clinician and, on the other hand, the different agents of the community who
deal directly with the adolescent.
12
The clinic is one of the many possible means of providing for this vital
communication. Indeed, the proper functioning of the clinic is in no small
way dependent on the successful use of the channels of communication
between the clinic staff, the judges and the probation department. There is a
great need for the establishment of many more lines of communication which
would lead to exchanges between the clinician and the police, the adminis
trators of detention agencies and the like. The fulfillment of this need could
serve only to increase and enrich the understanding of the problem of both
sides. This redounds to the benefit of the troubled adolescent and ultimately
to that of the whole community.
DR. NORBERT Bromberg
Consultant Psychiatrist
13
HISTORY OF THE NEW YORK CITY YOUTH BOARD
During and following World War II, the nation was concerned with the
problem of helping communities organize to combat the rise in juvenile de-
linquency. In 1945 the New York State Legislature created the New York
State Youth Commission, whose responsibility is outlined in its “Declaration
of Intent." The New York State Youth Commission Act states:
"As a result of existing conditions it becomes necessary for government
to supplement and aid in coordinating the care and guidance furnished
to young people by the family and by existing religious and social insti-
tutions. It is the intent of the legislature to encourage the municipalities
of the state to undertake increased activities in this field by the assist-
ance of a state commission created for this purpose and by provision
for the allowance of state funds."
In 1947, the Mayor and the New York City Board of Estimate decided
that the city should avail itself of the provisions of the State Youth Commis-
sion. The necessary financial appropriation was made, the New York City
Youth Board was established and an Executive Director was appointed by
the Mayor. Under the provisions of the State Youth Commission Act, local
communities were enabled to set up programs for the prevention and con-
trol of juvenile delinquency, with the state and local governments sharing
equally the cost of financing the programs. Funds were allocated by the
state to the locality. The allocation was to be based on the most recent
census (1940). An appropriation of $.25 per capita for each child under
twenty-one was available from the state. If a Youth Bureau was established
and an integrated program developed, the state contribution could be in-
14
creased to $.50 per child under twenty-one. New York City qualified for the
maximum per capita state grant of $.50 per child under twenty-one years
of age. The New York City Youth Board's budget of $2,471,850 (1954-55
fiscal year) permits it to offer expanded casework, group work, recreational
and clinical services through entering into contractual agreements with
existing voluntary and public agencies. Experimental and special demon-
stration projects are financed by Youth Board, or carried out as direct opera-
tions. Research and evaluation of each project is undertaken periodically.
In 1948, before embarking on a program, the Youth Board decided to
learn from a typical local community what its lay and professional leaders
and neighborhood groups believed should be involved in a program for
the prevention and control of juvenile delinquency. With a special appro-
priation from the Board of Estimate, the Bronx Pilot Project study was
undertaken. This study in community organization of the existing resources
and needs of the area was in itself an experimental project involving all
levels and representatives of the life of the community. It included a study
of the police, courts, schools, churches, treatment agencies, group work and
recreation, housing and Department of Welfare services. Panels for each
of these resources were organized; with staff assistance, particular services
were explored and evaluated in terms of the adequacy of the service in
relation to need, quality and effectiveness. The recommendations of this
study were published and the pattern was established for Youth Board
services and programs.
Because of the size of New York City and the vast need, the principle was
established of concentrating services in areas of greatest need and highest
delinquency. Eleven such areas are designated throughout the city and
funds are allocated on a contractual basis to established agencies offering
services in each of the areas.¹
The basic philosophy of the Youth Board stems from its concern for
serving families and children in the incipient stages of their problems and not
known previously to existing public and voluntary agencies, and those
families whose problems and attitudes make it difficult for them to use
available services without considerable preparation, reassurance and inter-
pretation. In order to locate these families, referral units, closely related
1. A more detailed outline of services rendered by the New York City Youth Board can
be found in the Board's publications, Pattern for Prevention and Reaching the
Unreached.
15
to schools and other sources of referral in the community, were set up in
each of the eleven areas. Schools and community agencies refer parents
and children to these units and the casework staff works with these parents
and children until some plan can be evolved and an appropriate referral
made. Staff for this assignment had to be selected carefully; in addition to
their professional training, they needed and were given special orientation
and on-the-job training to help them develop methods, skills, and techniques
of working with families not ready to use available treatment agencies.²
The goal of the Youth Board is to coordinate, integrate and strengthen
community services for families and children and to point the way toward
different approaches through its experimental and demonstration projects.
In this way, the Youth Board's program of better service to more families
and children can be achieved and all families will benefit.
The Magistrates' Courts Clinic is one of the special projects sponsored
by the New York City Youth Board and the City Magistrates' Courts.
2. This process is described more fully in How They Were Reached, New York City
Youth Board Monograph No. 2, 1954.
16
INTRODUCTION
In recent years, considerable information has been gathered about the
nature, needs, problems and treatment of the adolescent in conflict. It is
generally accepted that most adolescents are to some extent troubled during
their period of physical and emotional maturation. The physical changes
can be easily identified, but it is more difficult for the adolescent and those
around him to appreciate the extent to which he is changing and growing
emotionally, particularly since this growth is so uneven. It is perplexing
for a parent to watch the perpetual swing from child to adult which takes
place from day to day and from situation to situation. Because the adolescent
often has the physical appearance of an adult he is expected to behave like
one, yet overnight he can and does return to the behavior patterns of the
young, dependent child.
It is common knowledge that adolescents challenge the authority of
parents and that this is a part of establishing the balance and bridging
the gap between childhood and adulthood. Parents who are secure in the
relationship with their children can tolerate the confusions, the mood swings
and the testing-out processes, with the assurance that with patience, firm-
ness and understanding, the daily challenges can be weathered and the
adolescent will eventually emerge as an independent, secure and well-
balanced individual.
17
The parent who is less secure and has troubles of his own, reacts more
directly to the unpredictability of the adolescent, thereby adding to the
confusion and uncertainty of the adolescent. It is with the group of parents
and adolescents known to Girls Term, Probation and Women's Courts that
the Magistrates' Courts' Clinic is primarily concerned. In addition to the
usual and anticipated conflicts, these parents face the problems stemming
from earlier misunderstandings incompletely and inadequately met. There is
an intensification on both sides of the feeling of not belonging, not under-
standing and of not being loved. The usual adolescent's challenge is met
with challenge, and the inevitable response is acting out, flight from home
and parental teaching, and the repudiation of parental standards. The parent
retaliates with pressure to conform or is completely unable to set limits and
controls and the result is further chaos. Eventually the situation becomes
so acute that the parents are no longer able to tolerate and control the
youngster. The anxiety about where and with whom he spends his time when
away from home, the fear that he or she is becoming involved with “bad
companions," the knowledge that the behavior has progressed beyond the
socially acceptable motivates parents to seek the help of the court. Other
youngsters have actually become involved with the police and are brought
into court as "wayward minors." Parents usually seek the services of the
court as a threat or as a means of compelling the child to conform.
Agencies and other responsible groups concerned about the plight of
these parents and adolescents have recognized that this is a group in the
community in need of preventive treatment, not only to forestall more serious
involvement in anti-social activity, but to preserve the strength of the family
and the individual. Our general knowledge and understanding of the func-
tioning of these adolescents is limited. It is known that many of them are
from homes considered adequate from the physical and material standpoint,
but that the emotional climate has been unhealthy over a period of years.
Parental guidance and control have been too strict or too loose. Lack of
stability in the marital relationship may be a factor, or lack of undersanding
and acceptance of common and mutual interests in each other and the
adolescent prevail. The adolescent has not learned as a child to accept
the authority of church, home, school and community, and as he reaches
adolescence he lacks the inner control he needs to accept external controls
and disciplines required to meet the pressures of life. The physical
break from parents is made, but he is not ready to face the demands made
by parents and society. Conflict emerges in all of the areas where self-
discipline is required. Parents are faced with the extreme symptomatic
behavior of the adolescent who refuses to go to school, to work, to control
experimentation in the area of sex and to accept parental guidance.
18
Contact with this group reveals that they are not usually burdened with
guilt, but are actively engaged in acting on their impulses and satisfying
their needs. The anxiety, fear and concern underlying their aggressive and
defensive behavior has to be understood in relation to their lack of inner
strength, conscience and inner control. Work with them has to include help
in developing inner control over their impulses so that they will be able to
eventually accept authority in its broadest sense.
This is the challenge that the clinic staff of the Magistrates' Courts of
the City of New York is meeting daily. They feel that the challenge has
been met satisfactorily and that during the first five years of their experience,
they have learned how to help the group of acting-out adolescent delinquents
which has been considered "unreachable." The way has been rocky, the learn-
ing uneven, but the satisfactions many. As in all work with people, stress
has to be placed on the conscious use of the patient-worker relationship as
an enabling force in helping the client to want to change. Understanding the
dynamics in each situation has involved using the skill, ingenuity, interest
and understanding of each staff member in his contacts with the adolescent.
This includes the judge, the probation staff and the members of the clinic
team, administrator, psychiatrist, psychologist and psychiatric social worker.
How this has been done will be shown in the following chapters.
19
I. why a psychiatric clinic is needed in the
magistrates' courts
For many years, there has been growing concern about the rise in delinquency
in the adolescent and young adult groups and the conviction that detention
for the purposes of punishment or protecting society is not enough. It has
long been recognized that many of the difficulties in which our youth were
involved were becoming more serious, but that the youths committing these
acts of aggression against society were not the known or habitual criminals.
The courts, through the establishment of the parole and probation systems,
attempt to offer a selected group an opportunity to return to society, and
with guidance and direction some are able to rehabilitate themselves and
to avoid future conflict with the law. A considerable proportion of proba-
tioners and previous offenders return to the courts involved in new and
often more serious crimes.
There continues to be widespread concern about what can be done to
prevent the repetitive acts and to avoid placement in correctional institutions
except for those who obviously should not remain in the community. It has
long been recognized that by the time youths reach the correctional institu-
tion they have established patterns of behavior that are difficult to change.
Despite the gains made in classifying, separating and treating the younger
offender, removal from society, the stigma attached to this, and possible
association with the habitual offender are obstacles to healthy growth.
21
Rehabilitation Process
Criticism from some groups in the community has been leveled at the courts
for using probation unwisely, but the courts, faced with the dilemma of send-
ing a youth to a training school or reformatory, have preferred to take a
chance on offering the adolescent probation and an opportunity for rehabili
tation. It is needless to point out that the serious overcrowding and other
conditions in institutions make it difficult for the court to use these resources
even when the need for such treatment is clearly indicated.
Sociologists, criminologists, social workers, and all persons concerned
with this problem have insisted that it is necessary to study each offender,
to learn what causes him to seek this way of life and to offer treatment to
the individual based on the knowledge, skill and understanding available
through religion, psychiatry, sociology, psychology, social work and related
fields. Information has been gathered by representatives of these groups
relating the rise in crime to the conditions prevailing in the immediate
family, community, nation and world. Individuals become more tense,
anxious, insecure, aggressive, fearful and hostile when there are depres-
sions, wars, the threat of atomic warfare and military service. Religious
and civic leaders stress the laxity and the lowering of moral standards and
behavior. Some adolescents lack the inner strength, judgment, security and
maturity to withstand the pressures of living under these conditions and
unconsciously choose a way out which may eventually lead to crime.
For these and other reasons, the Magistrates' Courts of New York City
eagerly accepted the opportunity of establishing a psychiatric clinic in the
court setting, when approached by the New York City Youth Board. The
establishment of such a clinic would make it possible for the court to learn
more about why an adolescent resorts to delinquent behavior, what his
potentials for treatment are, what treatment services he needs and who is
best able to offer them.
Existing clinics and social agencies in the community were not able to
accept many court referrals. Although concerned about the plight of these
youngsters, voluntary community agencies have decided to accept primary
responsibility for helping those families which they feel recognize the need
for help and will seek it voluntarily. The number of adolescents known to
the court and in need of treatment, far exceeds the services available in
community agencies. There is insufficient knowledge, understanding, skill
and experience in working with this group of delinquents. Probation workers
have repeatedly expressed concern about the dearth of treatment facilities
22
and the difficulties they meet in attempting to refer to appropriate agencies.
A few of the voluntary social agencies do offer treatment for adolescent
delinquents, but most agencies are not geared to work with the aggressive,
acting-out delinquent. Philosophy and function of the agency, the training
and skills of the workers, staff shortages and the difficulties in involving
these adolescents in a treatment relationship have led agencies to limit their
services to applicants ready and able to use help. Many adolescents have
difficulty in relating to adults, and the adolescent delinquent is too fearful,
threatened and defensive to recognize that help is needed.
In addition, it was felt that there might be a decided advantage in having
a clinic closely affiliated with the court, whose staff would have knowledge
of the court's philosophy and function, as well as the professional training
and experience to treat individuals with serious emotional and behavior
problems. How the clinic staff might use the authority of the court as a tool
in involving parents and adolescents in treatment was an aspect of the
demonstration or experiment which would make the clinic different from
other community clinics.
In the summer of 1948, the psychiatric clinic sponsored by the New York
City Youth Board was established in the Magistrates' Courts for a two-
month trial period. Following the administrative review, it was
mended that the clinic continue to operate on a year-round basis. In line
with the fiscal procedure affecting all Youth Board projects, it is necessary
each year to approve continuation. This has been done from 1949 to date,
and it is hoped that the clinic will eventually become a part of the regular
court budget.
In general, its purpose is to offer the Magistrates' Courts psychiatric,
diagnostic and treatment services for those adolescent delinquents and their
parents selected by representatives of the court and clinic staffs as suitable
for treatment. A selection had to be made since the clinic staff could not
be expected to have meaningful contact with the large number of adolescent
offenders coming before the court. Since the primary function of the clinic
is to offer treatment to the adolescent and to help the court and community
understand the problems, needs and behavior of the adolescent delinquent,
those responsible for setting up the clinic and planning for its services
had to reach some difficult decisions about who could be helped, how,
what staff could be secured with the money available, how the court and
clinic staff could work together, and who in the court and clinic should
take administrative responsibility for the clinic.
23
II. staff, structure and relationship
of the clinic to the courts
In setting up a new service it is never possible to anticipate all of the specific
problems which will arise in performing the daily job. The experience of
the psychiatric clinic was no exception. Much time and effort went into
working out effective methods of operation. What seemed to be simple
problems of inter-communication between the various disciplines represented
on the clinic staff, probation staff and court personnel had to be met. Ques-
tions of who would take ultimate responsibility for the administration of the
clinic, recruitment of staff, setting policies and handling the daily details
of exchange of information, selecting clients for treatment and establishing
policies which would determine the direction of the clinic, had to be
resolved.
The usual delays and problems were encountered in establishing and
coordinating the clinic service with the ongoing court program. The process
of integrating philosophy, clarifying function and goals, training staff, estab-
lishing sound administrative procedures was a time-consuming one. These
difficulties were not insurmountable, yet they had to be recognized and clari-
fied early in order to pave the way for establishing a relationship between
the various disciplines represented in the groups participating in this coop-
erative and experimental venture.
24
Part Played by the Youth Board
As in all projects financed by the New York City Youth Board, the actual
responsibility for operating the project is assumed by the agency to which
the grant is given. The Youth Board is available for joint planning, con-
sultation and periodic review of the work of the project. Frequent con-
ferences were held with the court and clinic staffs in order to clarify problems
which arose during the early period. Consideration was given to the way
in which philosophy, goals, policies and procedures were implemented. There
was joint sharing of experiences and of problems in order to arrive at a
method of approach consistent with the function of the disciplines and pro-
fessional groups represented and the special needs of the adolescents and
their parents.
The function and aims of the court, the probation department and clinic
are similar, yet each has to rely upon the knowledge, skill and professional
competence of the other disciplines in order to arrive at an understanding
of the total needs of the adolescent and his family.
In order to coordinate the efforts of both court and clinic, the Chief
Magistrate appointed a committee of three judges¹ to be responsible for the
administration of the clinic. An experienced psychiatric social worker was
employed to act as clinic administrator. The responsibilities of the clinic
administrator include screening of intake referred by the probation depart-
ment, casework supervision, liaison with the judges and court personnel,
administration of the project under the general direction of the Committee
of Judges, and regularly scheduled conferences with the consultant psychia-
trist on all aspects of the treatment program.
In addition to the clinic administrator, the present staff consists of a
part-time consultant psychiatrist who has responsibility for the therapeutic
content of treatment, two part-time psychiatrists who work in direct treat-
ment, a full-time counseling psychologist who in addition to giving intel-
ligence, projective and aptitude tests, carries a few patients in treatment
under a psychiatrist's supervision, two full-time psychiatric social workers,
and three clerical staff members. The consultant psychiatrist usually gives
one hour a week to the clinic administrator, meets with the entire clinic staff
every week for two hours and has one hour for individual consultation with
the other members of the staff. The clinic has one unit record for a family
and all staff members who have contact with the adolescent and other family
members record their contacts in this record.
1. Judges Horn, Bloch and Thurston.*
* Now a justice with the Domestic Relations Court.
25
At the weekly staff conference, the agenda prepared in advance includes
discussion of general problems of interest to the clinic staff, and two or
three case situations. There is free discussion and exchange of information
in these sessions, which are used to keep the staff informed, to stimulate
interest in new developments in the clinic and to consider various treatment
aspects of the situations discussed. Whenever the schedule of the probation
officer assigned to the particular case permits, he attends the staff meeting
and participates in the case discussion.
Originally it was hoped that the clinic staff might be able to set up
coordinating and integrating conferences with the probation staff that would
serve to spread the base of understanding of mental hygiene concepts used
in the clinic and to bring both staffs more closely together. This plan could
not be carried out since the rate of turnover in the probation and clinic
staffs made it difficult to plan ahead with any certainty of continuity. In
addition, the probation staff available had to carry double assignments
because of staff vacancies. From the clinic's point of view, the amount of
time spent in such general training sessions would decrease appreciably the
availability of clinic services to the patients.
Ways in Which Clinic Services Are Used
The judges in the court and the court staff members have learned to use the
clinic services in a variety of ways. The clinic might be asked to interview
an adolescent or a parent, to make a quick determination of how disturbed
or retarded an individual is or to suggest a tentative plan based on a diag-
nostic evaluation of the situation. Referrals are made to the clinic on the
recommendation of the probation worker or the court for a more detailed
and complete diagnostic study and a determination of the adolescent's treat-
ability. The clinic is sometimes used for consultation to help in evaluating
and determining what kind of plan should be recommended. Conferences
are held with the judges, when requested, in order to help in thinking
through a plan on an individual case or to elaborate on a particular concept
which needs clarification.
There are a few categories or types of problems which the clinic staff
feels are unsuitable for treatment in the court clinic where relatively short-
term therapy is offered. Usually patients addicted to drugs, chronic alcoholics
and those with a history of long-standing homosexuality, psychosis and
serious mental retardation are not accepted for treatment. Psychiatric experi-
ence has shown that adolescents with these symptoms require prolonged,
intensive psychotherapy. It is felt that the clinic is not prepared to offer
26
this type of treatment, while meeting the other demands for service, without
seriously curtailing its service to patients who are more accessible to
treatment.
In a recent paper,2 Dr. Jerome Rose, one of the psychiatrists formerly
attached to the Magistrates' Courts Clinic and Dr. Norbert Bromberg, con-
sultant psychiatrist to the clinic, discussed the contribution made by the
psychiatric treatment clinic in the court dealing with adolescent delinquents.
They state that the general public has accepted the need for psychiatric
treatment for the younger delinquents who are known to the Children's
Court, but there seems to be less readiness to offer treatment to the older
adolescent in conflict with the law or in danger of becoming so involved.
They further point out that while most cases referred to a psychiatric clinic
from the usual sources can be adequately diagnosed in one or two sessions,
there are dangers in attempting this with adolescents referred by a court.
They have found that it sometimes takes eight to ten sessions to arrive at a
reliable diagnostic conclusion in the latter kind of case. Because of the
adolescent's problems, a more extended period of time is necessary to estab-
lish useful contact with him. In addition, Drs. Rose and Bromberg remind
us, the court-referred adolescent is not on his own initiative, seeking the
help of the court or the clinic. His response in the beginning contacts,
therefore, is conditioned by suspicion and fear of the therapist which results
in the tendency to minimize if not entirely to deny his problems. Hence,
much of this time has to be spent in offering emotional support, under-
standing and encouragement to gain the adolescent's confidence.
During this initial period the probation officer is helpful in encouraging
and stimulating regular clinic attendance. When the psychiatrist has gained
the confidence of the adolescent, he is able to rely upon the strength of
this relationship throughout the treatment contact. He is then free to proceed
as he would in any other treatment relationship, using his skills and knowl-
edge to help his patient to recognize, understand and handle his problems
and conflicts.
Parents who come to the Girls Term Court are usually asking the court
to use its authority to restrain or control the adolescent's behavior, to remove
her from home for protective purposes or to order her to behave. When
these parents and adolescents are referred by the court to the psychiatric
clinic, the clinic staff members have to convince the parent and the adolescent
that the clinic is concerned with helping rather than disciplining them.
2. Bromberg, N., and Rose, J., Problems of Consultative Services in a Psychatric Clinic
for Adolescents Attached to Courts.
27
The following case illustrates how the court used the clinic in a situation
where it was not clear what plan should be made in behalf of the adolescent
girl brought to the court by a mother who was herself obviously seriously
disturbed emotionally. The court needed help in determining the extent to
which the adolescent had already been damaged by her life experiences
and the best plan for her.
The clinic's evaluation of this situation, its work with Mary, and its
decision to help her shows one of the ways that early clarification of the
degree of disturbance and the availability of therapeutic help is essential
to any court working with adolescents.
The handling of this case illustrates how the court used the clinic
services to determine how disturbed Mary and her mother were, whether
either or both could be helped through treatment and finally whether imme-
diate separation and placement was necessary.
MRS. ROGERS brought Mary, age sixteen, into court complaining that Mary
made unreasonable demands on her and when they could not be met she
resorted to violent temper tantrums, used vile language and assaulted her
mother. In addition, Mrs. R. accused Mary of staying out until one or two
o'clock in the morning. Because of the intensiy of he feeling evidenced by
Mrs. R. and Mary and because each expressed the desire for immediate
placement, the court remanded Mary to a temporary residence for girls
and referred the situation to the probation department for investigation.
The probation officer obtained information from Mary, her mother, the
school she attended, a hospital where Mrs. R. had received treatment when
mentally ill and social agencies where the family had been known pre-
viously. In summary it was learned that Mrs. R. had two older sons.
One is employed, living at home and sharing in the household expenses,
and another is in military service. These are Mary's stepbrothers. Mary
is a child born out of wedlock who has never had a sustained contact with
her father or a father substitute. When physically and emotionally able,
Mrs. R. works to help maintain the family. It has always been a struggle
for her to do this. She had a serious mental illness and prolonged hospi-
talization was necessary.
This illness occurred when Mary was eight years old and she was placed
in an institution for children, where she remained until she was fourteen
and one-half years old. She was discharged when her mother demanded
this, although the agency was opposed to her return home. The agency
could not retain her against her mother's wishes. Mary made a fair adjust-
ment while in the institution, but like many children who are placed in
28
institutions, she was slow in her physical and emotional growth. Every
person who had contact with her, commented on her small stature, her
baby-face, her lack of emotional maturity and her infantile behavior.
It is not strange that she is repeatedly described as "physically and emo-
tionally underdeveloped," when her early experiences are understood.
Everyone was equally impressed by Mrs. R.'s expression of hostility
toward her daughter, her lack of understanding of how this affects Mary
and the extent of Mrs. R.'s emotional problems. It is not hard to under-
stand what effect living in such a household would have on Mary prior
to her mother's hospitalization and after her release from the institution.
Despite this, the probation report indicates that Mary was able to attend
school regularly and was considered an average student. She was also
able to work on a part-time job after school and she used the money
earned to meet her personal expenses. She was in her proper grade
placement in high school.
On the basis of this study the probation worker recommended referral
to the court psychiatric clinic for a complete psychiatric study and treat-
ment. In the meantime both Mary and her mother asked the court to
permit Mary to return home. The court placed Mary on probation and
referred her to the clinic for a study and recommendations concerning her
accessibility to treatment while living at home, and an evaluation of the
need for placement.
The clinic accepted Mary and did an exploratory study. The initial
clinic contacts included an interview with the psychiatric social worker, a
psychological work-up including intelligence, personality and aptitude
tests and four psychiatric interviews. As a result of the initial or diagnostic
study completed, the clinic recommended that Mary continue in treat-
ment. The report to the court indicated that a residential treatment plan
would be preferable, but it would be difficult to locate one which would
meet Mary's particular needs, in view of her withdrawn, infantile behavior
and her occasional, but violent, impulsive temper tantrums. Since it was
difficult to help her through individual therapy (at times she showed
extreme difficulty in expressing herself), she was placed in a therapy
group. The clinic felt that her behavior was not the expression of ado-
lescent conflicts but an indication of her functioning on the level of a
five- or six-year-old child who resorts to temper tantrums when faced with
frustrations which are intolerable. The court accepted the clinic's recom-
mendation and Mary was continued on probation.
The probation officer worked with Mrs. R. in an effort to relieve some
of the pressures in the environment and Mary related to the probation
officer reporting regularly on how she was getting along at home, school
and community. From September, 1953 through December, 1953,
29
Mary attended seven group sessions at the clinic and had three interviews
with the psychiatric social worker. She was absent at two group sessions.
The group sessions were conducted by the psychiatrist. The goal of the
group treatment was to help the individual members through group dis-
cussion and group relationships, to develop some understanding of what
is expected of adolescents in terms of standards of behavior and attitudes.
It was hoped that Mary through this process could begin to have some
understanding of how she was functioning.
During this period the clinic learned that both Mary and her mother
were in constant conflict. Mrs. R. refused to provide food for Mary at
home. The mother ate in restaurants and gave Mary just enough money
for carfare to school and clinic. Mary barely managed to earn enough
for her minimum needs. Mary was attending a private high school where
a small tuition was required. Her mother complained that paying tuition
was a waste of money and held over her the constant threat of refusal
to pay this. It was possible for the clinic to obtain a scholarship for Mary.
In interviews, Mrs. R. brought out how difficult it was to control her
hostility toward Mary and her fear that she might kill her and that Mary
might kill her. Mary reported that her mother wished for her death and
her grandmother's death by painful and violent means. Mary described
her mother as superstitious, ridden by fear, and queer. Both took their
conflicts to their neighbors and discussed each other without restraint, in
an effort to gain support from the neighbors. Unfortunately the psychia-
trist who conducted the group sessions left the clinic and it was necessary
to transfer Mary to individual therapy.
Although the clinic anticipated that it would be difficult for Mary to
accept the change in worker and to use individual therapy, Mary was
able to continue in treatment and she was able to keep her regularly
scheduled weekly appointments with the psychiatric social worker. These
totalled twenty-six kept appointments, four broken appointments and one
cancelled appointment when she telephoned to arranged another one.
At the end of the first year, the clinic indicated that Mary was able to
use the reassurance, sympathy and support given by the worker. She
learned to use her interviews to relieve her inner tensions and to discuss
her conflicts in relation to herself and mother. Through this process she
was able to mature slowly and to begin to have some understanding of
her mother's illness and to react to her mother as a sick rather than a
rational, responsible woman. There were fewer clashes, temper tantrums
and retaliatory acts, and Mary was able to use her energy in constructive
behavior. She still has mood swings when she needs to and does revert
to infantile behavior, but these occur less frequently, and Mary is able
to talk to the psychatric social worker about them. She was able to use
her inner strengths, redirecting and controlling her impulses and to accept
30
some of her mother's limitations. She was able to attend school regu-
larly and the school reported that her adjustment was satisfactory. She
continued on a part-time job and assumed financial responsibility for her
personal expenses.
Mary's probation was terminated when the probation worker felt that
there was marked improvement in Mary's adjustment. The clinic feels
that Mary is an essentially healthy adolescent who will be able to sustain
some of the gains made in treatment and that if necessary she will be
able to seek help in the future.
This case indicates the way in which the clinic was able to work with a
sixteen-year-old adolescent girl, helping her through support, reassurance
and recognition to develop some understanding of herself, and her mother's
emotional illness, so that she was able to tolerate if not accept many of
the frustrations of living in an environment which was almost completely
negative and destructive. Although the initial treatment goal was directed
toward Mary's removal from home, contact with Mary and her mother
revealed that this goal would be difficult to achieve, not only because of the
limited residential treatment facilities available, but because Mary's im-
mature and infantile behavior would make it difficult for her to adjust in
a residence with adolescent girls of her own age group. In addition, Mary's
mother had used the threat of placement punitively and it was necessary
for the worker to move slowly in relation to discussing possible plans for
separation. Despite the fact that Mary and her mother asked for placement,
both had mixed feelings about this and used the possibility of separation at
times of crisis to achieve their ends.
In retrospect, it is not too difficult to evaluate the meaning of the court
experience, probation and clinic service to Mary. It is safe to assume that
without the sympathy, understanding and support of each of the agency
representatives with whom she had contact, she would have regressed to more
seriously disturbed behavior and illness. Although placement seemed initially
to be the best solution, it was not possible for Mary to use this because of
her own needs and the difficulty of finding just the right spot for her in the
facilities available in the community. Through the combined efforts of all
of the workers involved, different aspects of the problems facing Mary and
her mother were attacked. The court offered the needed safeguards and pro-
tection to Mary and Mrs. R., the probation officer handled those aspects in
Mary's environment which needed modification and stood by until she was
able to make an adjustment. The clinic helped Mary to reach a better
understanding of herself, her relationship with her mother and her mother's
illness. Through this process she matured and learned to tolerate what
appeared to be an intolerable situation.
31
III. the intake process
In the original plan for the psychiatric clinic of the Magistrates' Courts, it
was intended that it should serve as many courts as possible. In the first
year, referrals were accepted from Brooklyn and Queens Adolescent Courts.
as well as those courts serving adolescents in Manhattan. The clinic is lo-
cated on the sixteenth floor of the court building at 100 Centre Street. Because
of the relatively small size of the clinic staff, its geographical location, and
the therapeutic goals of the clinic, it soon became apparent that if the full
value of the clinic was to be maintained, intake would have to be limited
to those courts which were centrally located, which could best make use of
the clinic service and whose staffs could benefit from direct association and
communication with members of the clinic team. The decision was reached
to terminate clinic service to Brooklyn and Queens Adolescent Courts and
to concentrate service to Girls Term Court, adolescents served in Women's
Court and the special Probation Unit of the District Court. Most of the
referrals are made from Girls Term Court probably because the kinds of
problems handled in this court can be treated more effectively in a psy-
chiatric clinic.
Questions are often raised about the fundamental differences in the
functioning of a psychiatric clinic in a court setting and a voluntary clinic
where emphasis is placed upon the applicant's recognition and awareness of
the need for help and his readiness to seek it. Recognition of the problem
and willingness to take responsibility for seeking help is often used as a
measure of the applicant's concern, and his ability to take the initial steps
can be related to his motivation for change.
32
While the adolescents referred to the psychiatric clinic of the Magistrates'
Courts do not consciously seek help with their problems, their acting-out
behavior is often their way of indirectly pointing up their need for help.
Many of the adolescents are brought into court by their parents, guardians
or relatives because the family feels that they can no longer tolerate or
accept their behavior. Parents often state that they feel that they have lost
control over their son or daughter and then proceed to relate many examples
to support their accusations. Sometimes the behavior is serious and has
occurred over an extended period of time. It usually relates to association
with questionable companions, returning home in the early morning hours,
unexplained absences from home, refusal to attend school and suspected
sex activity.
At other times adolescents are brought into court by a police officer
because the youth has been apprehended following involvement in an un-
lawful act, such as absconding from home without parental consent, theft
of a car, rape or other aggressive sexual activity, assault, or unlawful entry.
In neither instance does the adolescent seek out the court voluntarily, but
there are times when the youth expresses relief that the situation has crystal-
lized and that some action will be taken. In the case cited earlier, the
relationship between Mary and her mother had seriously deteriorated.
Although she was frightened and anxious about the court experience, she
asked for placement since she saw separation from her mother as a means
of escape from the constant nagging, accusations and recriminations.
Procedure
Whether the adolescent is brought to the court by a member of the family
or a police officer, the procedure is the same. The parents and youth are
interviewed separately and sufficient information is obtained to determine
if the court has jurisdiction. If there is a basis for court action, a petition
is drawn up. This specifies the circumstances and nature of the situation
and the statement of both parties concerning the precipitating factors and
the extent of involvement. The youngster is brought before the judge who
reviews the material, advises the parents and youth of their respective
rights and takes temporary action based on the seriousness of the situation.
The youth may be placed in the custody of the parents pending probation
study and recommendations, remanded to a temporary shelter pending
investigation or a psychatric study, or hospitalized for observation. When
the court needs a quick determination of how disturbed a parent or ado-
lescent is or whether the adolescent is seriously retarded, the psychatric
clinic is used on a consultation basis.
33
After the probation study is made and a decision is reached by the court,
the probation investigation material is sent to the clinic administrator. This
material is reviewed and a determination is made concerning the adolescent's
suitability for clinic referral. Often, the probation department or the judge
has recommended referral to the clinic. Adolescents accepted by the clinic
are usually on probation or parole. The probation department offers the
adolescent a referral to the clinic, discusses this with him and the parents
but gives no further interpretation of the clinic service. The clinic staff
takes responsibility for interpreting its services, what is involved in treat-
ment and the adolescent's responsibility for keeping appointments regularly.
The clinic also decides who is to be involved in treatment. The adolescent
may be interviewed initially by any member of the clinic staff, psychiatrist,
social worker or psychologist, depending upon the individual situation and
availability of clinic staff.
The adolescent receives a letter from the clinic staff member to whom
the assignment has been made, inviting him to come into the clinic for his
first appointment. If this appointment is not kept, follow-up letters are sent.
The probation department is notified if there is no response to three letters.
Appointments are offered, taking into consideration what is known about
the schedule of the adolescent. The clinic is open one evening a week for
appointments with employed adolescents or their parents. Usually, initial
appointments are kept or responsibility is taken for canceling and arranging
another appointment.
During the intake process, the interviewer explores the adolescent's
understanding of why he was referred to the clinic, what he expects and
how the clinic functions. The voluntary nature of the clinic's relationship is
stressed, but the adolescent understands that the probation department will
be informed of the regularity of clinic attendance. The confidential nature
of information given to the clinic is also explained.
The clinic's intake or diagnostic study includes interviews with the ado-
lescent and his parent, a psychological work-up if the need is indicated and
a psychiatric evaluation of the adolescent's behavior, personality, level of
adjustment and potential for treatment. A tentative diagnosis is made con-
cerning the nature, depth and type of disturbance.
When the intake process has been completed, the clinic notifies the court
that the adolescent has been accepted for treatment. From that point, com-
munication between the probation department and the clinic is determined
34
by the development in the case and the adolescent's probation status. When
necessary and for a short period of time, the clinic will continue to work
with an adolescent who is discharged from probation.
The court consults frequently with the clinic staff to consider what is
best for an adolescent, even though it may be clear that the clinic will not
be able to accept him for treatment on a continuing basis. The clinic takes
on responsibility for this consultative service to the court and the facilities
of the clinic are used in arriving at a better understanding of the needs of
the adolescent and the resources available to meet his needs. The recom-
mendations of the clinic are discussed with the court and the court staff
takes responsibility for approving and implementing them. Conferences may
be set up to discuss the situation and to interpret and clarify the recom-
mendations. It is felt that this is an essential service which the clinic is
able to give in those situations where treatment is not needed or is not
available.
The following case describes a typical situation which the clinic accepted
for diagnostic study and consultation.
MR. BACON, age 45, brought his seventeen and one-half-year-old daughter
to the Girls Term Court. He stated that he found it impossible to control
her behavior and requested placement to avoid her involvement in a more
serious situation. He indicated that she began to cut classes and to truant
about five months ago. He permitted her to attend a party around this
time on condition that she return home at a specified hour. She came
home on time, but she had been drinking. He discussed this with her and
in the course of the argument he struck her. She took him to court the
next day and it was suggested that he permit her to live with a family
friend.
Mr. Bacon and his wife have been separated for fourteen years. The
daughter, Jerry, has lived with various maternal relatives. She has not
lived with her mother or father for any significant period since they
separated. Mr. Bacon is regularly employed.
Jerry's version of what happened differed considerably from her father's.
She denied drinking and accused her father and his girl-friend of drinking
excessively and of abusing her when drunk. She said that the incident
described by her father was one of several. She indicated that she liked
school and attended regularly, but she explained that it was difficult to
study at home. She and her father live in a hotel and the girl-friend
lives with them. When they drink they become boisterous and she cannot
35
concentrate on her studies. She is reluctant to invite friends to visit her
since she is ashamed of the condition of the home and the behavior of
her father and his different girl-friends. Jerry is made to feel unwanted
and in the way of her father and his friends. There is a history of heavy
drinking on both sides of Jerry's family.
The school was contacted and indicated that Jerry attended school regu-
larly. Jerry had talked to the school about her difficult home situation and
the school was inclined to believe her since her behavior in school has
been satisfactory. They consider her slow, but interested and studious.
Jerry was placed in a temporary shelter at her father's request during
the period of the probation study. Her father felt that she needed pro-
tective custody, since he could not be responsible for her behavior and
conduct. She adjusted well at the shelter. At the completion of the study,
the probation worker recommended that she be paroled to her father for
a six-month period, pending determination of a possible plan for her.
The clinic was requested to complete a diagnostic study and to make
recommendations concerning Jerry's capacity, potentials, ability to adjust
in the community, her needs and possible plans. Jerry was eager to co-
operate in the court plans for clinic referral. She kept her appointments
with the clinic staff members promptly and participated freely in the
process of psychological testing and psychiatric interviews.
The results of the psychological, the Rorschach and other tests indi-
cated that Jerry was functioning on a minimal level intellectually. Her
actual score on the intelligence test placed her in the borderline group,
but it was felt that this did not reflect her real capacity and potentials.
Some impairment in the capacity to make full use of her intelligence was
evident. The Human Figure Drawing Test revealed confusion in her
identification with the male adult, whom she saw as a mischevious boy.
The adult female was drawn as a witch-like figure with protruding teeth,
menacing and disheveled. The Rorschach indicated that she was func-
tioning on the pre-adolescent or early adolescent level. Her approach to
her social environment was seen as disorganized and confused. It was
felt that she would not be able to deal realistically with her impulses and
that there was a tendency to project on the environment in a paranoid
way. Jerry was considered threatened seriously by adolescence and her
repression of sexual content was prominent. There was evident confusion
in her psychosexual identification.
In her two psychiatric interviews, Jerry expressed considerable feeling
around what she saw as her father's rejection of his role as a father and
his inability to accept adult responsibility. She was able to evaluate the
negative factors in her environment and she welcomed the opportunity
for placement in a residence when it materialized.
36
Although Jerry was tense and anxious in the first psychiatric interview,
she participated readily, discussing her plans for school, career and long
term goals, recognizing that she would not be able to rely on parental
support while achieving her goals. Her directness and strength in handling
areas of conflict was noted. For example, although she had a neurotic
fear of water and was not able to look at the water in the swimming
pool at school, she was able to accept the school's requirement of learning
to swim prior to graduation and was completing the course as required.
Her plans for a nursing career were discussed in detail and she was
prepared to accept the possibility of some difficulty in achieving this if
she could not meet the academic requirements. Her choice of this career
seemed to imply that she had some recognition of the lacks of her rela-
tionship with her mother and a need to sublimate and compensate for
this through mothering and caring for others.
The initial impression of the psychiatrist indicated that Jerry had good
potentials and could respond to a warm sympathetic and understanding
relationship with an adult. She was seen as lacking maturity and limited
in her ability to integrate emotional, social and intellectual factors. It
was felt that she needed a well-organized and stable environment such as
would be provided in a long-term residence placement with an oppor-
tunity for a continuing relationship with a warm, mature, understanding
adult and healthy association with other adolescents. The tentative diag-
nostic finding was of an adolescent with an immaturity reaction with some
neurotic features. It was felt that Jerry could use vocational guidance
and career planning periodically, to determine what is feasible in relation
to her intellectual and emotional level of functioning. Psychotherapy
might be helpful later as her environment becomes more stabilized. Psy-
chological testing should be repeated at a later period to determine the
level of functioning intellectually.
The court was able to use these recommendations in evaluating plans for
long term residence placement and treatment planning. Jerry has been
placed in a residence and all reports indicate that she is making a good
adjustment. She is responding favorably to the new environment.
This situation illustrates how an adolescent can be caught in emotional,
social and familial conflicts which might impair her functioning intellectu-
ally and in all other areas. Although Jerry was not involved in serious
anti-social behavior, the intervention of the court will make it possible
for her to enjoy the advantages of a stable healthy environment. This will
give her the opportunity for experiences and satisfactions needed by all
adolescents. It is anticipated that with re-direction, guidance and under-
standing, Jerry's chances for a healthier adjustment should be enhanced.
37
IV. the treatment process
The success of the psychiatric clinic of the Magistrates' Courts is closely
related to the courts' acceptance and implementation of its philosophy of
socialized and individualized justice and the clinic's conviction that the
upset and disturbed adolescents brought into court can and should be helped.
Clinic services must be available to troubled adolescents when such help is
needed and in a manner which is meaningful, helpful and acceptable to them.
Both the court and clinic staffs recognize that there is a segment of the
adolescent population that is not accessible to clinic treatment either because
they are so disturbed or defective that they are in need of protective, custodial
or institutional care or because it is not possible to treat them in view of the
limitations in our current knowledge and skills. Both the court and clinic
staffs are guided by the principle that society has the right and should
expect protection from the uncontrolled aggression of a limited or dis-
turbed adolescent who cannot adjust. On the other hand, there is recogni-
tion that the adolescent has a right to expect humane and rehabilitative
treatment when he has transgressed and there is a possibility that he can
be restored to a responsible functioning individual in society.
In the Magistrates' Courts, the facilities of the court and the clinic are
used in order to understand the adolescents' problems in their totality. The
court is primarily concerned with the administration of justice and protecting
the rights of the individual and of society. In the socialized approach, the
law can be interpreted in its broadest aspects with the focus on understand-
ing the impact of the law on the individual and the individual's motivations.
in breaking the law. Where intent and culpability are so closely related,
38
it is necessary for the court to consider not only the legal aspects, pro-
tecting the rights of the individual and society, but it is necessary to reach
a determination of individual responsibility from the sociological and psy-
chological aspects. In New York State and City, children under sixteen and
adolescents sixteen to twenty-one years old are treated differently from
adults. The court turns to psychiatry, case work, psychology and probation
for help in determining what has caused the adolescent to act out and if
and how he can be helped to change. Each of the professional groups in-
volved contribute its understanding of why the adolescent has difficulty
and the court uses this understanding and interpretation in reaching a
decision.
When the clinic accepts an adolescent for treatment, it takes full responsi-
bility for determining the kind of treatment required, sharing with the
court, as the need arises, recommendations which the staff feels are essential
to the adjustment of the adolescent which are beyond the function and scope
of the clinic to implement. For instance, if after working with an adolescent
it is felt that the home environment does not offer the kind of experience
essential to the well being of the adolescent and that placement is indicated,
this is discussed with the probation department and an attempt is made
to plan for the adolescent outside of his home.
Functions of the Therapist
As in any psychiatric clinic, the role of the therapist is to enable the
patient to look at himself in relation to his life experience, behavior and
attitudes and to reach some understanding of himself, to gain a different or
broader perspective, and to change or modify some of his patterns. The clinic
does not limit itself to one approach, but in general tries to explore all of
the facets of the adolescent's adjustment as seen by the adolescent, family
members, school, employers and other key members in the environment.
Part of this experience with the clinic staff enables the adolescent to
recall in the interview his fears, anxieties, concerns, feelings and attitudes
which he has not been able to share with others. In preparation for this the
therapist has had to work toward establishing the kind of relationship based
on warmth, understanding, confidence, trust and acceptance to enable the
adolescent to respond to him. This may be preceded by much testing-out by
the adolescent as evidenced by broken appointments as well as the use
of challenging and provocative behavior in the interview. The therapist
accepts the adolescent's behavior, clarifying and interpreting whenever pos-
sible his function and role and how the clinic can help. Gradually the
39
adolescent learns to accept the fact that the clinic staff is there to help and
not punish. This is accomplished slowly and after the adolescent has been
able to express his hostile feelings and give up his fear and suspicion of the
therapist's motivations.
When this stage is reached, the therapist is able to begin to help the ado-
lescent understand himself. The adolescent, through his regard for and
identification with the psychiatrist, is willing to listen to him sympathetically
and to develop more healthy attitudes toward himself, his parents and the
outside world. Thus the "authority" of the therapist, his professional knowl-
edge, skill, understanding, sympathy, sensitivity and controlled firmness,
enables the adolescent to re-evaluate and modify his way of life.
The clinic naturally feels that it can be most helpful to those adolescents
who are beginning to show signs of maladjustment rather than those with
deep seated emotional and personality problems. This relates not only to
the nature and degree of disturbance, but to the best use of staff time. Since
the staff is small and the services have to be limited, the selection of cases
for treatment is determined in part by their accessibility to relatively short-
term treatment.
The division of responsibility varies with the needs of the individual
situation, but usually the psychiatrist has responsibility for the direct treat-
ment relationship with the adolescent. The psychiatric social worker may
treat the mother or the family member most closely involved with the ado-
lescent under psychiatric supervision. Occasionally, adolescents are carried
in treatment by the psychiatric social worker under the direct supervision
of the consultant psychiatrist or by the psychologist. Psychological testing
is requested at the appropriate time by the therapist responsible for the
treatment relationship. The results of the psychologicals are fully recorded
by the psychologist. The total findings are summarized diagnostically by
the psychiatrist.
The staff conference is used for clarification of the diagnostic thinking
and treatment plan on the individual case, for sharing and pooling ideas,
and for teaching purposes. The consultant psychiatrist takes responsibility
for the professional content of the staff meeting, but suggested items for the
agenda are submitted by any staff member to the clinic administrator. In
addition, the consultant psychiatrist confers with the administrators on over-
all clinic problems and with the total clinic staff on the handling of indi-
vidual cases in treatment.
40
The following case situations illustrate how the total resources of the
clinic and its staff members are used in helping the adolescents and their
families who are referred by the court for clarification of the diagnostic
picture and treatment. Contrary to common belief and understanding, both
of these adolescents had families who were interested in them and the ado-
lescents had the usual physical and material comforts available in low or
middle-class homes. One was intellectually superior and had high educa-
tional goals. Neither adolescent was able to live up to his own or his
family's expectations and each at the time of the clinic referral was func-
tioning below his capacity.
During the fifteen months of active contact with the clinic Henry kept
twenty-two appointments with the psychiatrist, failed eight and cancelled
six. There were eleven treatment interviews with the psychologist and one
cancelled.
HENRY S., eighteen years old, was brought into court on a disorderly con-
duct charge. He was accused of "peeping" into a neighborhood home.
The probation study revealed that Henry is the youngest son in a family
of six children, all of whom are married and living away from home.
His parents have a history of serious and prolonged marital conflict.
Henry has lived alone with his mother since he was eight years old. His
mother was described as emotionally disturbed and chronically ill for
the past ten to twelve years. The probation worker felt that Henry was
under constant pressure and nagging by the mother and older brothers.
His father supported the mother and Henry, but he remained aloof from
family affairs. Henry was attending a local college and hoped to become
a doctor. He worked during summer vacations and in the evening to meet
his personal expenses. His IQ placed him in the superior range.
·
Henry was referred to the clinic in January 1952. The initial diagnostic
interview with the clinic psychiatrist indicated that Henry was an ex-
tremely disturbed youth who might be in need of hospitalization. In the
initial interviews Henry was described as tense, anxious, helpless and
confused. He was having extreme difficulty in concentrating on his college
work and described particularly problems in relation to carrying out
his laboratory work. He was fearful of his assignments and could not
dissect animals. He revealed much hostility in his relationship with his
mother and one older brother whose wife was not a member of his
religious group. He produced ideas of reference and persecution and
expressed fear of being called for the draft.
Henry frequently broke his clinic appointments or cancelled them because
he did not get up in time to keep them. During this period when he
41
kept an appointment he was bewildered, confused and infantile in his
reactions. He needed considerable support and reassurance and he made
constant demands. There were periods when he could not attend some of
his classes and when he was not able to work. The psychiatrist recognized
Henry's underlying anxieties, hostilities and fears which interferred with
his functioning.
An effort was made to determine if the conditions at home could be modi-
fied. In view of Mrs. S.'s physical and emotional illness the psychiatric
social worker visited her home. She found substantial confirmation of the
material relating to the extremely damaging relationship between Henry
and his mother. The psychatric social worker decided that it would not
be possible to work with the mother, but with Henry's consent, an older
interested brother was interviewed and given some interpretation of
Henry's problems and needs. His help was obtained and he was able to
serve as a buffer between Henry and his mother. The brother was particu-
larly helpful, since he had been in treatment himself. He gave informa-
tion concerning the father's prolonged detachment from the family, his
mother's punitive handling of all family members, her inability to use
money, her unpredictable behavior and the family's general attitude of
ridicule toward Henry. The brother felt that the family could be involved
in helping Henry if he had a physical illness, but he felt that they could
not see the need for taking responsibility in paying for treatment of an
emotional illness.
Later in the contact, Mr. S. was interviewed. He was cooperative and
concerned, but ineffectual and passive. He had some understanding of
Henry's illness and he indicated that he would encourage him to continue
in treatment. He talked about his effort to redirect and divert his wife's
pressures on Henry and his flight and withdrawal when she became un-
controllable. As an example of his wife's unreasonableness, he explained
that he gave her his entire check. He lived on the proceeds of his over-
time work.
In June 1952, when Henry seemed to become increasingly disturbed, a
psychological study was completed. This showed that he was functioning
in the bright normal range but that he had the potential for a higher
score. The Rorschach showed an exaggerated use of projection as a de-
fense, strong identification with the female, an over-attachment to the
mother figure, accompanied with extreme fear of her. The female was
seen as a devouring figure. It was felt that his security lies in his intel-
lectual achievement and that he has the need to see himself as a superior
person. There was conscious verbalization of his problems of conflict
and jealousy between parents and children and he saw his mother as
his competitor rather than as a helpful adult. Diagnostically he was
42
seen as a paranoid schizophrenic with superior intelligence, but with im-
pairment in his intellectual functioning.
Later because of Henry's concern about what the tests revealed, even
though the psychiatrist had given Henry an interpretation of the results.
and reassurance about his functionign, the psychologist discussed Henry's
questions around the specific meaning to him. Henry was intellectually
able to accept this interpretation.
Throughout the first ten months of Henry's clinic contact, there were
intervals when Henry was able to function adequately and periods when
he was overwhelmed by his fears, anxieties, doubts and suspicions. Much
of the content of the interviews during the latter period related to hal-
lucinatory and delusional material. In July 1952, the clinic considered
hospitalization, since it was felt that he might respond to the combined
therapeutic approach available in a hospital. There was difficulty in
working this out because of the conflict in Henry's and the therapist's
vacation.
Mrs. S. eventually went away for the summer, and Henry and his father
remained at his home. Except for minor crises, Henry was able to manage,
and by fall he was ready to return to college. He reported that he was
tense and anxious the first day, but he began to develop self-confidence.
The therapist felt that he was improving and that he was better organized
and integrated. He began with encouragement to experiment with social
contacts and he became friendly with two schoolmates. He began to
discuss ways of handling his mother, recognizing that submitting to her
was not satisfactory. Instead of taking on his mother's delusions, he was
able to separate the delusional content and to begin to evaluate it in
terms of the reality situation.
At the end of the first year considerable improvement was noted in his
social adjustment, his academic achievement and his family relationships.
He developed limited understanding and insight concerning his difficulties,
and he was able to act in relation to his new understanding. Although he
was not able to leave home, he was less provocative when home and he
was able to tolerate his mother's behavior without retaliation.
In making preparations for resigning, the therapist discussed his plans
to leave with Henry. Henry was able to request transfer to the psycholo-
gist with whom he had some contact earlier. It was possible to do this
and Henry continued in treatment for a short period. His scholastic record
for this term has been raised to "B" and "C's" in contrast to last year's
"C" and "D's." At the end of January 1953, the probation department
decided in conference with the clinic that Henry had improved sufficiently
43
to be discharged from probation. The clinic decided to continue to work
with Henry for a brief period.
Henry continued, but he began to taper off his contact. There was a
marked change in the interview content. In contrast to his early com-
plaints, projections and delusions, he was able to discuss his awareness
of his competiveness in terms of the negative aspects, his relationship with
his mother, his fears and his distortions in relation to his feeling for
people. Although the original symptom involving his court difficulty was
not discussed, it was evident that Henry was reaching out and forming
relationships with his peers and that he had given up his compulsion.
By May 1953, Henry had tapered off his clinic contact and it was de-
cided to close the case. Henry has telephoned the clinic since the closing
when he has needed help and he has been able to accept referral to a
clinic in the community. It was felt that Henry should be able to take
this step. The court clinic sent the necessary summary to the community
clinic to make the transition less difficult for him.
It is probable that Henry is one of the many individuals in our
society who will remain vulnerable to emotional crises. With the help he
has received from the court clinic, he will probably be less reluctant to
seek help as the need arises. The insight he has developed should enable
him to understand himself better and to make more constructive use of
his capacity and potentials.
Many adolescents have difficulty during the period when they are learning
to establish themselves in the world of adults. For so many years, they
have been completely dependent on their parents and it is extremely difficult
for them to maintain a sense of balance while striving for independence.
emotionally and continuing their dependency relationship financially. During
this period some questioning of parental authority and control usually
occurs. Parents who are secure in their marital relationship and those who
have established a firm base of understanding and affection with their chil-
dren during early years are better equipped to accept their adolescent's
behavior, giving them the necessary support, guidance and direction.
Many of the parents of the adolescents referred to the court clinics are
in conflict with themselves as well as with their children. There is a lack
of understanding and agreement in many areas, but the use of discipline
and control presents a particular problem. These parents, particularly the
mothers, have not had the experience of relating to understanding sympa-
thetic parents in their own childhood. They are likely to carry into adult
life their feelings of anxiety, guilt and hostility. When challenged by the
44
conflicts of their adolescents, their own fears and hostilities are aroused and
reactivated. These parents project their feelings on their children, often
accusing them of the acts which they as adolescents committed or wanted
to commit. Their children act compulsively, living out the expressed and
unexpressed wishes of the parents.
The following case shows how the psychiatric clinic of the court was
able to involve an aggressive, pugnacious adolescent in treatment. This
youth had had earlier contacts with child guidance clinics and had
been committed by the court to a residential treatment facility for boys
with emotional and behavior problems. His earlier contacts pointed up his
extremely erratic and assaultive behavior and his inability to cooperate and
participate in the treatment relationships.
GEORGE SHERMAN, eighteen years old, was the youngest in a family of
three children. An older sister was married and his brother was attending
college. The mother indicated that both of her older children had no
problems and were well-adjusted. George's father was regularly employed
and the family income was adequate. The parents had been married
twenty-five years. In 1951, Mrs. Sherman appealed to Domestic Relations
Court, Children's Division. She stated that she considered George incor-
rigible. Investigation revealed that when George was nine years old, he
had been referred to the Juvenile Aid Bureau on a minor complaint but
the mother denied that there was reason for concern.
In 1947, the school was concerned about George's behavior and adjust-
ment and referred him to the school clinic. The school described him as
a bully and a discipline problem and added that the mother could see no
wrong and projected responsibility for his behavior on the school. The
school clinic report highlighted the poor relationship between George
and his parents and concluded that there was no evidence of warmth in
the relationship. He was of average intelligence and had decided interest
and ability in art.
The parents could not be involved in treatment and George coasted along
for the four years, until the mother appeared in Children's Court to file
a delinquency petition. She claimed that he was beyond her control,
stole from the family, and ran away with the money. The high school
reported that he had transferred from one high school to another at
his request and had failed most subjects. His attendance and punctu
ality were poor and he was considered a behavior and conduct problem.
On the basis of these facts and George's feeling toward his family, Chil-
dren's Court committed George to an institution for boys with behavior
and emotional problems. This agency reported that George was not re-
45
sponsive to their group treatment program. He saw compliance to group
rules as a weakness and he was a source of difficulty throughout the
fifteen-month period of contact. Since he did not respond to this treat-
ment program, he was paroled to after-care, with the recommendation
that he secure individual treatment through this agency's child guidance
clinic. The agency offered George and his parents several appointments,
but they failed to keep any of them.
Soon after George was discharged to after-care, he was arrested on a
charge of felonious assault. He and a group of boys tried to enter a
church social without admission tickets. They were not admitted, but
remained on the outside, became noisy and boisterous, and used vile
language. When a man came outside to remonstrate with them, George
attacked the man and knocked him down. As a result, the man was in the
hospital for several days. On his discharge, he identified George as the
attacker and his arrest followed. George was adjudged a wayward minor
and was referred back to the institution for psychiatric treatment. The
institution accepted him in October 1953, but came to the conclusion
three months later that he was pre-psychotic, a risk to the community and
in need of psychiatric treatment in a hospital setting. It was not possible
to arrange for his hospitalization in voluntary hospitals, and George re-
fused to use the public resources. The court was notified of the institu-
tion's recommendations and decisions.
The probation department of the District Court made a referral to the
psychiatric clinic. Since the referral to the clinic seven months ago,
George has been scheduled for weekly appointments with the psychiatrist.
He has kept twenty-seven, failed four and cancelled three.
During these sessions, George has revealed marked anxiety about his
latent homosexuality. In his contact with the psychiatric social worker
in the institution, George had gained some awareness of his sexual con-
flicts and homosexual trends. He developed marked anxiety around this,
and fought constantly as a means of asserting and proving his mascu-
linity. Although he is not an overt homosexual, he phantasies about his
associates, develops anxiety that his controls will break down, and
becomes assaultative to prove his superior masculinity.
George has talked about his parental and familial relationships. His
parents had not planned for his birth and George had been made to feel
unwanted. The unfavorable comparison of George with his brother and
sister has impressed him with a feeling of inferiority. He is unusually
tall and large for his age and has always stood out in any group because
of his size, yet he was fearful of physical attack and felt impelled to
become the aggressor. His father had beaten and derided him at the
46
slightest provocation and his mother had supported the father in this.
Since George has been in treatment at the clinic, he has worked regularly.
Previously he had not been able to hold a job more than two or three
months. He is beginning to discuss occupational planning with a view
toward the future. His delinquent and hostile behavior has subsided com-
pletely. George has worked through his fears and doubts concerning his
masculinity and he has given up his "hard guy" approach. He finds that
his friends accept and like him, and he is developing a healthy interest
in girls. He has a hobby and in general his adjustment is on a sounder
basis.
It is felt that George should continue in therapy in order to solidify
the gains made. His relationship with the probation officer has been helpful
and useful to him. He has and needs a warm, accepting probation officer
who can communicate respect for authority without stimulating his
hostility.
In his interviews, George has brought out much unconscious material in
the sexual area. He has been helped to gain respect and confidence in
himself and to gain perspective in relation to his worth and value as an
individual. The therapist has become George's masculine ideal and the
identification with him has enabled George to feel accepted and gain
confidence in himself through being accepted as a male.
Therapy has interrupted the cycle of delinquent behavior, and abuse
of others to compensate for his treatment by parents, associates and others.
The joint acceptance, controls, understanding, support, and interpreta-
tion which George experienced in his relationship with the therapist and
probation officer were important to the treatment plan. George had some
intellectual understanding that his earlier behavior could not be tolerated,
but without the right combination of factors in the circumstances and the
skills, personality and understanding such as the therapist and probation
officer provided, George was unable to use the help offered.
In the beginning the clinic had planned to involve the probation staff
in clinic staff meetings in order to offer regular scheduled opportunities
for communication, orientation, and exchange, through discussion of initial
problems, policies and the handling of individual case situations. At the
present time, consultations between the clinic staff and probation staff are
held on individual cases and in addition the probation officers are invited
to participate in staff meetings when individual cases are discussed.
It is sometimes necessary for the Girls Term Court to act in behalf of
an adolescent, assuming protective custody when the parents are unable to
47
assume their function of adequate direction and guidance and the adolescent
is in danger of becoming involved in serious delinquent behavior.
The following case situation, involves the referral of a seventeen-year-
old girl, known to the court on three different occasions, for absconding
from home. She was able to follow through on the last referral to the psy-
chiatric clinic. Although she is in the beginning stages of her relationship
with the clinic there is some indication of an ability to make use of the
treatment relationship and evidence of her capacity to develop some insight
concerning her problems and a willingness to work on them. She had not
followed through previous attempts at clinic referrals. Although in the first
instance, illness was a reason for the failure to use the clinic's offer of
help, it was evident that the parents' and the adolescent's tendency to mini-
mize the seriousness of the problems was an additional factor.
BEATRICE was brought in to Girls Term Court by her father about a
year ago. He was concerned because she had left home twice and had
been found in mid-Manhattan under questionable circumstances. Each
time she had been away from home a few days, before she was found.
Her father, Mr. Carter, indicated that Beatrice began to present diffi-
culties just before she reached her sixteenth birthday. Although up to
this time, she had been getting along well in school, she began to lose
interest in it, cut classes and truanted. The school adjusted her program,
but this did not help. She was permitted to leave school at sixteen. Since
then she has held several jobs, but for short periods of time. Her work
habits are not good, but Beatrice has been able to resign from each job
prior to dismissal. The family of eight had a regular income, but lived
in a small apartment and could not afford to move to a larger one. They
planned to buy a house when a settlement was made of an accident case.
In the original court contact Beatrice expressed concern about her run-
ning away and indicated that she might need psychiatric treatment in
order to understand her behavior. The probation study confirmed the data
given by Mr. Carter concerning the family and marital history. Beatrice's
school problems, employment history and behavior. Beatrice is the oldest
of six children. Mrs. Carter gave birth to her sixth child during the
period of Beatrice's most recent episode. His wife, although her hospitali-
zation prevented her from taking a more active role, supported Mr.
Carter in the court action. Both parents expressed bewilderment and
concern about their daughter's behavior, but they were warm, accepting
and non-punitive in their relationship with her.
Mr. Carter revealed that Beatrice was born out of wedlock, but that he and
his wife had kept this information from her. Later information revealed
that Beatrice had some concern and questions about the differences in
48
her physical appearance and that of her brothers and sisters. She had
some recollection of attending the wedding of her parents. Her parents
were not able to handle this with her. As a result of the first court appear-
ances, Beatrice was placed on probation, returned home, and referral was
attempted to the psychiatric clinic. She failed all clinic appointments,
but kept her probation appointments when her health permitted. She
seemed to make a good adjustment and was discharged from probation.
In the late summer of this year, Beatrice was picked up by the police in
a neighboring state. She had been observed drinking in a bar and since
she seemed to be under age, she was questioned. She and her companions
were held for a short time, but Beatrice was permitted to return home
with her father. Mr. Carter filed a petition in Girls Term Court and a
warrant was issued at his request against his daughter. She was brought to
court and remanded to a shelter for girls. Mr. Carter asked for a physical
and mental examination.
Beatrice related that she had run away with two girls to participate in a
roller-skating derby. The girls had promised that they could arrange this,
but the promises had not been kept. When apprehended she was in the
company of these girls and some young men. The physical examination was
negative, but Beatrice indicated that she had had some exploratory sexual
experience. Beatrice was not able to adjust while in the residence and it
was believed that she planned to escape. She attracted attention by her
noisy behavior. The probation department recommended probation for an
indeterminate period up to three years, referral to the clinic, her return
to home, and full time employment.
The clinic accepted the referral. Beatrice has been scheduled for four
appointments with the psychiatrist. She has kept three of these and
cancelled one. In the clinic's opinion, Beatrice will be able to use
psychiatric treatment. In her first session Beatrice was able to bring out
material which highlighted her problem of running away from unpleasant
situations and her involvement in an automobile accident with her brother
which resulted in a serious injury to him. Apparently he was permitted
to take over the controls of the car temporarily and while in traffic he
became involved in a accident. Although the brother and parents absolve
Beatrice of responsibility for the incident, Beatrice blames herself and
is ridden by anxiety, becomes depressed and broods. Since the accident
occurred near her home, she passes the scene frequently and panic sets in.
Her running away periodically is tied in with her association of the
accident with the area and her inability to handle her overwhelming feel-
ing of responsibility for what happened. The therapist believes that
Beatrice through her running away and disturbed behavior is trying to
punish herself and to seek punishment from others for what she sees
as her culpability. She is constantly returning to the scene of the
49
accident and trying to involve herself in a dangerous situation which will
result in injury to herself and acting in a manner to attract attention
to herself so that she can be apprehended and punished.
In the second session, Beatrice was mute and uncooperative. On explora-
tion, she was able to discuss her feeling of resentment and hostility based
on her referral to the clinic and her fear of being considered "crazy."
She was depressed throughout the interview, cried easily, but was helped
to reveal her anger and resentment at the therapist and clinic. In her
third interview, Beatrice seemed more accessible to treatment. She brought
out material concerning an earlier injury and subsequent fainting when
she is in high places. This has led the therapist to recommend a neuro-
logical examination to determine the possibility of organic involvement.
The clinic feels that Beatrice will be able to continue her relationship
with the therapist, that she is accessible to treatment and has the potential
to accept and use the treatment relationship to gain a better understanding
of herself. The warmth, support, encouragement and understanding of
the therapist will enable her to share her inner concerns and feelings
more readily as she gains confidence in the therapeutic relationship and
the therapist is able to recognize and handle her resentment, anger, fears
and anxieties. Since the probation officer will continue to maintain close
supervision during this beginning period, the clinic will be assured of an
opportunity to get to know Beatrice better, to confirm its tentative diag-
nosis and to adapt its treatment goals to her needs.
50
V. characteristics of adolescents
referred to the clinic
If it is possible to determine the basic difference in the personality structure
and behavior of those adolescents referred to the court clinic, something
might be learned of causation and treatment possibilities. This could be
helpful in setting up delinquency prevention programs based on early
detection, diagnosis and treatment. It can be seen on the basis of the cases
described earlier that the youths referred to the clinic come from vastly
different economic, family and environmental situations and that their native
intelligence varies considerably. Although all of these factors might con-
tribute to or intensify the adjustment problems of the adolescent, it has
not been possible to isolate from them any one element which would dif-
ferentiate the potential delinquent from the non-delinquent. In determining
the causes of delinquency the Gluecks have found that there are certain
factors in the family and early life experiences of children which tend to
differentiate the delinquent from the non-delinquent.1
The New York City Youth Board is now applying the Glueck Prognostic
Table in a research project with the first graders of two Bronx schools.
This research project will be followed up for several years. If the scale
is validated, the results can have a vast impact on planning services and
agency programs for children. It would enable agencies to offer concen-
1. Glueck, Drs. Sheldon and Eleanor. Unraveling Juvenile Delinquency, Commonwealth
Fund, New York, 1952.
51
trated and intensive treatment services of a preventive nature to those
children rated as potential delinquents before they become involved in
delinquencies.2
In reviewing the actual diagnostic classifications arrived at in the clinic,
they seem to fall within the usual range of possible classifications, but none
are specific to delinquency. The largest number, in the group of 178 closings
in the year 1953, were diagnosed as neurotic character disorder (78), with
a fairly equal distribution scattered in all of the other possible classifications.
Much has been written about the effect of early affectional deprivation,
the importance of the relationship with the mother or mother substitutes,
father or father substitute during the early formative years, the possible
influence of physical and organic defects, the meaning of constitutional
factors and the impact of environmental and social deprivations. It is gen-
erally recognized that delinquency causation is complex and because of the
multiplicity and complexity of the factors and elements involved, it is diffi-
cult to isolate any one factor or combination of factors which would lead
to the development of the delinquent personality.
The experience of the staff of the court clinic would tend to substantiate
this, but some tentative differences have been noted. These relate primarily
to the absence of guilt and the concomitant lack of concern about transgres-
sions which lead to aggressive acting-out. In recent years, our understanding
of the varied functions of the ego and super-ego have helped to define and
classify more accurately those individuals who in the past would broadly
fall within the group of psychopaths or psychopathic personalities. This
redefinition has made it possible for the court clinic to offer more effective
treatment based on this new understanding to those delinquents who make
use of their services.
Frequently, in addition to the immaturity, instability and infantile de-
pendency usually encountered in these adolescents, there is an absence of
concern for the way in which their behavior will affect themselves and others.
There is a tendency to project on others and to expect immediate gratifica-
tion of all wishes and desires. It has been pointed out that although the
chronological age would place these youngsters in the adolescent group,
many are functioning emotionally on the level characteristic of the five- to
six-year-olds. This of necessity complicates the treatment possibilities, since
2. New York City Youth Board. Validation of Glueck Table for Identification of Juvenile
Delinquents, December, 1953.
52
the demands of the adolescents, their physical drives and their need for peer
relationships throws them into contact and conflict with other adolescents
who are able to function more adequately.
Personality Development of Adolescents
Referred to the Clinic
With many of the adolescents known to the clinic, it would appear that
their growth in the areas that relate to self-conrol, discipline and socializa-
tion have become fixed at an early level in their development. Dr. Bromberg,
consultant psychiatrist for the Magistrates' Courts Clinic is of the opinion
that many of these adolescents have not had the experience of a warm,
affectionate relationship with their parents, especially the mother, during
the early impressionable years. This early deprivation has made it impos-
sible for them to identify with the verbalized teachings of the mothers and
to incorporate the parental (mother's) avowed standards of behavior in
their functioning. This aspect of their development stops at the early
primitive level and only identification with the hostile parental behavior
and fear of the parent remains.
3
This hostile type of behavior and the fear of punishment rather than
awareness of responsibility becomes a motivating force in the behavioral
adjustment of these adolescents. The role of the therapist has to be directed
toward helping the adolescent to see that not all adults are demanding and
threatening. This makes it possible for the youth to relinquish his suspicion
and fear of him and subsequently of other adults. Where there is no fear,
there is no need for vengeful, defiant or defensively disruptive or destruc-
tive behavior.
Thus, it can be seen that these adolescents have learned in their early
years to fear, but not to accept any form of authority. Their development
has apparently become fixed at an early level and immediate gratification
of their wishes is imperative. Postponement in any form means rejection.
There has been no exposure to the use of positive authority and parental
guidance has usually been in the form of over control or too little control.
In either instance the youth has learned to fight for recognition or has
used flight into illness, phantasy life, or retreat, as a means of handling
difficulties. Many adolescent delinquents have learned that it is not possible
for them to gain status in their group or family as the "good" child and
they resort to the use of negative forms of behavior to achieve recognition.
3. See Bromberg, N. Maternal Influences in the Development of Moral Masochism. Paper
given at the 1954 meeting of the Annual American Orthopsychiatric Conference,
March 11, 1954, New York City.
53
An indication of the degree of their disturbance can be measured by the
evtent to which they withdraw, become suspicious of and are able to accept
any adult in their environment.
The following case illustrates how Alice learned to use illness, from
infancy to puberty, to protect herself from her feelings of being displaced
by her younger brother whom she felt was preferred by her family. As
she approached adolescence, she substituted truancy and defiance of parental
authority.
ALICE L., sixteen years old, was brought into court in March 1953 by her
mother and a detective. She had left home without her parents' consent
and in the company of her boyfriend, Jimmie, also sixteen. They had
gone to several southern states hoping that they would be able to marry.
They failed in their attempts since it was obvious that they were below
the age to marry without parental consent. When their limited funds were
exhausted, they were picked up, held in jail overnight and returned to
New York City. Jimmie was charged with abduction and Alice was re-
ferred to Girls Term Court.
Alice's parents are middle-aged. They have one other child, a son. Their
home is a comfortable middle-class home. Probation reports show that
Mrs. L. began to have trouble with Alice about a year ago about her wish
to withdraw from a private school and to attend a public high school.
Mrs. L. was opposed to this, but she conceded when Alice began to truant.
Alice made a temporary adjustment in the public school, but later her
truancy was resumed. The school and parents conferred and despite ad-
justments made in Alice's schedule she did not attend school, and when
she did go, she was inappropriately dressed. Prior to this behavior, Alice
had been an outstanding student of superior intelligence.
Alice was removed from school at the recommendation of the dean with
the understanding that she might return later. Around this time, Alice
began her association with Jimmie who is described as a passive, de-
pendent youth inferior to Alice in physical appearance, intellect and
personality. Alice assumed complete control of him, manipulating and
exploiting the relationship in relation to her needs. It was obvious to the
parents that Alice had assumed the initiative in planning the recent
escapade. Interviews with Alice elicited essentially the same information.
Alice's father was ill and he did not actively participate in the family
dispute. The younger brother was conforming and had parental approval.
From early childhood, Alice had used illness as a means of controlling
the family. When she was two years old, she had a serious feeding prob-
lem which required hospitalization. A few years ago, she was referred
54
to a child guidance clinic because of her difficulty in retaining food. The
medical findings were negative and psychotherapy was recommended, but
not followed up. At puberty the pernicious vomiting was given up, but
the acting out began.
The court remanded Alice to a temporary shelter pending further study.
The physical examination given at the shelter confirmed that Alice had had
sexual experience, but other findings were negative. The probation study
indicated that the family maintained a comfortable home in a residential
area and that the parents were recognized in the community as stable and
well established. Both parents had worked, but Mrs. L. stopped working
when Alice ran away. The parents had disciplined Alice by whipping
her, depriving her of privileges and withholding her allowance. These
methods were ineffective.
On the basis of the probation study, the court placed Alice on probation
for a maximum period of three years. She was returned home and referred
to the court clinic. The diagnostic study completed at the clinic indicated
that Alice was suffering from severe anxiety and that this limited her
functioning at school and on the job. She was described as a violent
reactor. Diagnostic classification was neurotic character disorder. The
psychological showed that Alice was of superior intelligence, but func-
tioning on an average level. She was hampered by debilitating anxieties.
In the Rorschach she saw the male as crawling and the female as yelling
and nagging. She was accepted for psychotherapy and was treated by the
psychatrist. The psychiatric social worker carried the mother on an in-
tensive basis. Weekly interviews were scheduled for both. During the
fourteen months of clinic contact. Alice kept approximately fifty appoint-
ments, failed to keep nine and cancelled five. Mrs. L. kept twenty-eight,
failed six and cancelled four.
During the early period of Alice's contact with the therapist, she was
defensive, hostile, provocative, and challenging. She repeatedly tested
him by telling of her continued association with Jimmie although this
was a violation of the terms of his probation as well as hers. She brought
him to the clinic and introduced him to the psychiatrist. She saw herself
as a martyr for love and welcomed the status gained and the opportunity
to embarrass and punish her parents. Although she did not share informa-
tion with her mother, she talked to her brother who relayed the informa-
tion to Mrs. L.
Recognizing that Alice was seriously disturbed and incapacitated, the
clinic felt that they should not attempt to prohibit her association with
Jimmie, but that she should be helped to understand the meaning of this
relationship and how she has used it. Since Mrs. L. was so deeply involved
55
in Alice's functioning, the contact with her was directed toward helping
Mrs. L. recognize and understand how she was contributing to Alice's
problems through her attempted use of rigid controls.
The clinic's understanding of Alice was shared with Jimmie's probation
officer as well as with Alice's. Both Alice and her mother were able to
relate to their therapists, bringing out in their discussions their feelings,
attitudes and problems. Gradually they gained some understanding of
themselves and by October 1953, Mrs. L. was described as less rigid,
anxious and controlling.
It is clear that the clinic and probation staff, in recognizing and accept-
ing Alice's behavior as symptomatic of her inner turmoil, were able to help
her and her parents after they had gained confidence in the clinic's interest.
In the interviews with Alice and her mother, it was possible to elicit infor-
mation which helped the staff understand the confusions, tensions and con-
flicts which affected all of their relationships. Through the process of looking
at themselves and their behavior, Alice and her mother were able to give
up some of their infantile and immature behavior and to gain limited
understanding of what had been happening to them. When Alice learned
to place value upon herself, commensurate with her capacity, she was able
to use her potentials in constructive activity. Her mother gained some
understanding of the way in which she provoked and stimulated Alice.
She was able to become less punishing and hostile. With the lessening of the
tensions in the home, all family members were able to get along better.
Without the help of the clinic and the cooperation of the judge and
probation officer, it is probable that Alice would have continued to act out
her defiance of parental authority and would have become more seriously
involved in difficulties at home and in the community.
D
56
VI. caseload analysis and treatment costs
The cost of psychiatric treatment services in any clinic is high. In clinics
where children and adolescents are treated, it is essential to involve parents
and other family members in a direct treatment relationship if treatment
given to the child and adolescent is to be effective. Because of this, all
children in the family and other family members derive some benefit, since
the increased insight of the parents and the persons directly involved in
treatment affects their relationships in the over-all family group. In the
psychiatric clinic at the Magistrates' Courts, every effort is made to involve
the parent or guardian with a member of the clinic staff, usually the psy-
chiatric social worker. An effort is made not only to interpret the needs
and problems of the adolescent, but to prepare parents for anticipated
changes in the behavior of the adolescent, to secure their understanding
and participation in the treatment goals and to help them understand those
factors in their relationship with the adolescent which affect his behavior
and responses. The successes or failures in treatment are usually related not
only to the response of the child or adolescent, but to the degree to which
parents can be helped. Even when the adolescent is removed from the home,
behavior patterns and family ties carry over in the new environment and
difficulties arise in the new setting. The adolescent seeks substitutes for
parents in a staff member of the residence, in the employer or other
relationships.
In carrying treatment cases, the psychiatric clinic has usually assigned
the adolescent to the psychiatrist or psychologist and the psychiatric social
worker is usually assigned to the parent. A larger group of adolescents
57
are carried in a direct treatment relationship by the psychiatrist in the
court clinic than in community clinics functioning under agency auspices.
In many child guidance and youth counseling agencies, it is usual for the
psychiatric social worker to carry treatment responsibilities with intensive.
psychiatric supervision.
The psychiatrists had a total of 697 interviews during 1954. Six hundred
and eighty-six were with the patient (adolescent) and eleven were with the
parents. The psychologist's interviews totalled 223, of which 221 were with
the adolescents. The psychiatric social worker's total interviews were 719,
297 of which were with the patient, 202 were with parents and 220 were
with other interested persons. Conferences and interviews with magistrates
and other court personnel totalled 611 and there were 548 reports sent
to the court.
In summary, there was a total of 2,240 interviews which the clinic staff
held with the patient, parent, family member, court personnel and other
interested persons. Approximately 75 per cent of these were interviews with
the patient or a family member and the balance involved interpretation of
the needs of the patient to the court personnel. The amount of time given to
direct interpretation to court personnel was supplemented by written reports
on 548 cases. It can be seen that interpretation of the needs of the indi-
vidual patient to court personnel is an essential part of the clinic staff's
job and that the exchange of needed information has become a part of
practice.
There was an experimental therapy group which started around the
middle of September 1954. This group was led by a psychiatrist and weekly
sessions were scheduled through December 1954. Forty-one adolescents have
been involved in these sessions.
The Youth Board's annual allocation for the operation of the court
clinic is approximately $39,000. This covers the cost of professional and
clerical services.
The clinic is able to work with only a fraction of the disturbed adoles-
cents known to the Magistrates' Courts. The limited budgetary appropriation,
which determines the amount of professional staff available, makes it im-
perative for the clinic to select those adolescents able to respond to treat-
ment in a relatively short period of time or to select for treatment those
adolescents in need of the less intensive forms of therapy. The obligation of
58
the community to widen the base of clinic coverage through adequate
appropriation is essential if the court is to implement its philosophy of
socialized individual justice. There is an immediate need for such an in-
crease in the appropriations if adequate diagnostic, treatment and probation
services are to be available, so that all adolescents known to the courts
who are accessible to treatment can be offered treatment opportunities.
Taking into consideration the complexity and size of the Magistrates'
Courts system which includes fifty-five tribunal units, a chief magistrate,
forty-nine judges and a quota for seventy-eight probation officers, the limita-
tions are obvious when the clinic staff includes one administrator, one
consultant psychiatrist, two part-time treatment psychiatrists, one full-time
psychologist, two psychiatric social workers and three clerical workers. It is
a tribute to the court and clinic staff that they have not been overwhelmed
by the immensity of the problem and that they have been able to accept
the satisfactions with the frustrations while keeping a sense of direction.
59
VII. court, clinic and community
Any study of clinic material gives evidence of the complexity of adolescent
delinquency and the advantage of professional services to meet the total
needs of the individual. It shows also what the court and clinic can do,
what the limitations are, and what the community must do in order to
prevent a further increase in juvenile delinquency.
Those young delinquents who will gain most from court and clinic
experience, are the ones who can find in their homes, schools, and groups
of associates some influences favorable to their advancing maturity. For
them, the psychiatrist's understanding of and help with their personalities,
problems, and needs can make an impact. Help given to parents by psy-
chiatric social workers and support given by probation officers increase the
chance of success.
In these hopeful cases and in the doubtful and more difficult ones,
change for the better often depends upon help that comes or might come
from agencies outside the court. The kind of help needed is not readily
available. Clinic social workers and probation officers find themselves
unable to secure the vigorous, understanding action required in many cases.
This is true in cases in which removal from the home is indicated, since
resources for foster care and residence facilities are limited. When long-
term direct help to parents is seen as important to treatment, voluntary
social casework agencies and public relief agencies often cannot offer their
services, so that referral is not possible. Sometimes in cases already under
their care effective cooperation is difficult. The negative quality of policy
60
and practice has been keenly analyzed by Dr. Harris Peck in his paper,
Resistance in Delinquency. “Resistance" within agency boards and staffs,
however related to realities, is a potent obstacle to progress in mobilizing
community resources for the treatment of delinquency. Professional edu-
cation still has far to go in the preparation of practitioners for participation
in comprehensive programs. The general public has yet to be united in
willingness and determination to support, with their interest and their money,
an adequate system of services.
There are many cases of delinquency known to the court and clinic,
which the clinic cannot attempt to serve since they are not considered readily
accessible to treatment. Prostitution and drug addiction are social and psy-
chiatric problems which baffle our present institutions and experts. Their
causes are deep-rooted in our society. In thinking of the many roots of
delinquency, it is important to remember the organized business enterprises
in vice, for they feed upon and in turn feed all kinds of anti-social deviations.
One of the facts of life for the adolescent is the existence of this thriving
illegal trade which makes its customers, but seemingly not its entrepreneurs,
the enemies of the law, and which has something to do with the question
of whether crime pays or does not pay. His own relationship to the forces
of law and order are conditioned by his awareness of this apparently
permanent part of his environment.
Among the interwoven causes of delinquency must be included de-
linquency itself, commercialized crime, and also many behavior patterns
more generally shared, for which it would be hard to fix blame on any one
group of people. We have seen that the movement of the courts toward a
social-judicial philosophy and procedure has led to a multi-discipline organi-
zation of the courts, and to treatment for rehabilitation based upon a joint
interpretation of psychiatric, social, ethical and judicial inquiry. This way
of dealing with adolescent offenders has in turn led to a better compre-
hension of the complex causes of the growth of delinquency in our com-
munity, which are beyond the sphere of clinic and of court.
Such an idea of cause must make us think more clearly of the need
for a multi-discipline community. A truly integrated body of professional
services would be both coordinated, and united in certain concepts of pur-
pose and method. They would have an intercommunication system, as court
and clinic have, and their personnel would share some basic knowledge.
It may be that no community as a whole can or should become completely
integrated, but acceptance of the principle of cooperation would in itself
61
ease some tensions, and such programs as that of the Youth Board would
receive support in finding and bridging gaps in service.
An institution superintendent said recently that children's delinquent
behavior is not hard to understand, but only hard to take. Most parents
will know what he means. It is hard to take, especially when we would
all like so much to hold ourselves blameless, and when we are so disturbed
and baffled by what happens to us and around us. We may remind our-
selves that even though there may be 40,000 child and adolescent arrests
in our city in a year, and even though that is far too many children in
trouble, it is after all only a small proportion of the million and a half
children between five and twenty years of age in our city.¹ Our young
generation is not, as a whole, delinquent; it is full of strength, and even
for the delinquent few, adolescence is a time of hope.
1. New York City Youth Board. Juvenile Delinquency Rates, 1953.
62
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